scholarly journals Role of serum albumin and body mass index in the outcome of major elective abdominal surgery

2019 ◽  
Vol 6 (4) ◽  
pp. 1165
Author(s):  
Yepeto Lohe ◽  
Sreejith V. ◽  
Raghvendra Sharma ◽  
Nyage Lombi ◽  
Harish M. ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Protein Energy Malnutrition ◽  
Frequency Standard ◽  
Prognostic Indicator ◽  
Chi Square ◽  
Risk Of Death ◽  
Protein Energy ◽  
Increased Risk ◽  
Student’S T ◽  
Nutritional Studies

Background: The prevalence of protein-energy malnutrition in surgical patients is high, ranging from 10% to 54%. The correct assessment of the nutritional studies of such patients is crucial since malnutrition is a risk factor for morbidity and mortality. There is a substantial evidence to show that patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves.Methods: 150 patients were selected for the study. All the collected data was entered in Microsoft Excel sheet. It was then transferred to SPSS ver. 21 software for statistical analysis. Quantitative data was compared by using student’s t-test and chi-square test, qualitative data compared using frequency, standard deviation and percentage. P<0.05 considered as significant.Results: The mean serum albumin was found to be 3.7 gm%±0.3. There was increase rate of complication and duration of hospital stay in those patients with serum albumin <3.5 gm% and BMI>25 kg/m2 and wound infection was found to be the most common complication among these patients.Conclusions: Majority of patients had serum albumin >3.5 gm/dl and more complications were seen with serum albumin <3.5 gm/dl which was statistically significant (p=0.01). Serum albumin is a good prognostic indicator because of its ability to detect protein energy malnutrition.

scholarly journals Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older

2015 ◽  
Author(s):  
Robert Robinson
Keyword(s):  
Risk Factor ◽  
Serum Albumin ◽  
Hospital Readmission ◽  
Lymphocyte Count ◽  
Protein Energy Malnutrition ◽  
Total Lymphocyte Count ◽  
Total Lymphocyte ◽  
Protein Energy ◽  
Patients At Risk ◽  
Low Serum

Introduction: Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods: All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results: The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan-Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI: 2.30-4.63) and higher DRG weight (Hazard Ratio 1.19, 95% CI: 1.03-1.38) to be significant independent predictors of hospital readmission within 30 days. Discussion: This study investigated the relationship of PEM to the rate of hospital readmission within 30 days of discharge in patients 65 years of age or older. These results indicate that laboratory markers of PEM can identify patients at risk of hospital readmission within 30 days of discharge. This risk determination is simple and identifies a potentially modifiable risk factor for readmission: protein energy malnutrition.

scholarly journals Acute Kidney Injury in Patients With Acute Chemical Poisoning: the Experience of the Toxicological Center in Ryazan

2021 ◽  
Vol 9 (4) ◽  
pp. 639-645
Author(s):  
N. V. Shatrova ◽  
M. N. Rudakova ◽  
L. G. Zaytseva ◽  
Zh. A. Varenova
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Poisoning ◽  
Annual Reports ◽  
Infusion Therapy ◽  
Chi Square ◽  
Exact Test ◽  
Risk Of Death ◽  
Increased Risk ◽  
Microsoft Office

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

DNA methylation status of Smurf2 promoter in patients with multiple myeloma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19537-e19537
Author(s):  
E. Hatzimichael ◽  
A. Dasoula ◽  
J. Stebbing ◽  
G. Dranitsaris ◽  
T. Crook ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Serum Albumin ◽  
Cpg Island ◽  
Methylation Status ◽  
Risk Of Death ◽  
Extramedullary Disease ◽  
Increased Risk ◽  
Beta 2 ◽  
Beta 2 Microglobulin

e19537 Background: Multiple myeloma (MM) is an incurable interleukin (IL)-6 dependent plasma-cell malignancy. Transforming growth factor-β (TGF-β) is the major inducer of IL-6 secretion by bone marrow stromal cells. The signaling responses to TGF-b are mediated by the Smad proteins. The Smurf2 gene (Smad ubiqitiniation regulatory factor 2) encodes a Smad-specific E3 ubiquitin ligase and targets Smad2 and Smad3 for proteasome-dependent degradation. Methods: Bone marrow samples from individuals with MM were obtained at diagnosis and in 5 cases at disease progression as well. Genomic DNA was isolated and bisulphite modification was performed using commercially available kits. The methylation-specific polymerase chain reaction was employed to study the methylation status of the CpG island. Logistic regression analysis was used to measure the association between gene methylation and the development of advanced disease (DS≥ II), extramedullary disease, bone disease, anemia (Hb 10 mg/dl), serum albumin and beta 2 microglobulin levels. Results: We analysed the methylation of Smurf2 in 45 cases of MM (24 male, 21 female, mean age 66.4 years). No sample from the control population was found methylated. The Smurf2 gene promoter was found to be methylated in 11/45 MM patients (24%). Interesting trends were noted where patients with methylated Smurf2 promoter had an increased risk of death (HR = 1.3; p = 0.68), anemia (OR=2.1, p=0.2) and advanced stage (OR=1.3, p=0.6) and a reduced risk of extramedullary disease (OR= 0.2, p=0.2). No association was found between Smurf2 methylation status and bone lytic lesions, serum albumin levels or beta-2 microglobulin levels. Conclusions: Interesting associations between Smurf2 methylation and some relevant clinical parameters in patients with MM were suggested by the data. These findings warrant further evaluation in a larger sample of patients in order to enhance our statistical power and better define the prognostic and clinical value of Smurf2 methylation in MM. No significant financial relationships to disclose.

Impact of clostridium difficile infection on gastrointestinal malignancies.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 170-170
Author(s):  
Stuthi Perimbeti ◽  
Rishi Shrivastav ◽  
Prateeth Pati ◽  
Kristine Marie Ward ◽  
Michael Styler ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Primary Diagnosis ◽  
Chi Square ◽  
Gastrointestinal Malignancies ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Control And Prevention ◽  
Chi Square Test

170 Background: According to the Centers for Disease Control and Prevention, there were half a million documented cases with 83,000 re-infections and 29,000 deaths due to Clostridium Difficile Infection(CDI) in the year 2011. The influence of CDI on outcomes in gastrointestinal(GI) malignancies is not well described, although the incidence is known to be higher in this subgroup of patients. Methods: National Inpatient Sample 1999-2014 was analyzed to identify adult admissions (>18 years of age) using ICD-9-CM codes with a primary diagnosis of esophageal(EC), Gastric(GC), Colorectal(CRC), Small intestinal(SIC), Hepatobiliary(HCC) and Pancreatic(PC) cancers. ICD-9 code 00845 was used to stratify these for the presence of CDI. We performed Chi-Square test to determine the in-hospital mortality percentage, and Cox Proportional Hazard model to control for confounders and determine the Hazard Ratio(HR) of death within 30 days of admission during hospitalization in patients with and without CDI. Results: See table. Conclusions: Despite controlling for potential confounders, patients with GI cancers and CDI are at an increased risk of death compared to those without CDI. Taking the more detrimental effects of CDI in this subgroup of patients into consideration, healthcare professionals should strive to avoid the inordinate use of antibiotics and strictly maintain current guidelines designed to prevent spread. It may be prudent to treat these patients as severe CDI, even if current criteria are not met. More scientific research is warranted in analyzing the specific outcomes of CDI in GI cancer patients and if more aggressive therapy for CDI is warranted, considering the limitations of this study. [Table: see text]

scholarly journals Association between Serum Albumin and Hypothyroidism in Preeclampsia: A Case-control Study

2021 ◽  
Author(s):  
Nineetha Muraleedharan ◽  
M Saboora Beegum
Keyword(s):  
Serum Albumin ◽  
Case Control Study ◽  
Correlation Coefficients ◽  
Case Control ◽  
Thyroid Stimulating Hormone ◽  
T Test ◽  
High Morbidity ◽  
Chi Square ◽  
Increased Risk ◽  
Control Study

Introduction: Preeclampsia is a cause of high morbidity and mortality in pregnant women. Serum albumin is found to be low in preeclampsia. Few recent studies have shown a state of hypothyroidism in preeclampsia. Aim: To find the association between the serum albumin and thyroid hormone levels in preeclampsia and seek to find if hypoalbuminemia increases the risk of hypothyroidism. Materials and Methods: A case-control study was done at Department of Biochemistry and the Department of Obstetrics and Gynaecology of Government Medical College, Thiruvananthapuram, Kerala, with 40 preeclampsia cases and 40 normal pregnant controls, in 30-38 week gestation. Serum albumin and thyroid profile-Total T3, Total T4, Thyroid Stimulating Hormone (TSH), freeT3 (fT3), freeT4 (fT4) were tested. Statistical analysis was done with Student’s t-test, Chi-square, Fischer’s t-test and Pearson’s correlation coefficients. Results: The mean serum albumin was significantly lesser in preeclampsia (3.11±0.39) than in controls (3.7±0.14 g/dL). Thyroid hormones were significantly decreased in preeclampsia. TSH was significantly raised (3.76±1.55 mIU/L) in preeclampsia compared to normal pregnant ladies (2.3±0.94 mIU/L). In cases with hypoalbuminemia, risk for hypothyroidism was 2.85 times compared to those with normal albumin but was not statistically significant. In severe preeclampsia, there was a two times increased risk. There was a negative correlation of TSH and positive correlation for fT4 with serum albumin. However, this was statistically not significant. Conclusion: Hypothyroidism in preeclampsia was not significantly correlated with hypoalbuminemia in this study. Thus hypoalbuminemia did not significantly increase the risk for hypothyroidism in our study. Further studies are needed to determine the risk factors affecting thyroid function in preeclampsia.

scholarly journals Serum albumin as predictor of post-operative morbidity and mortality

2017 ◽  
Vol 4 (3) ◽  
pp. 1078
Author(s):  
Latika Sharma ◽  
Poojan M. Purohit ◽  
Dharmendra Pipal ◽  
Saurabh Kothari ◽  
Harshit Srivastava ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Protein Energy Malnutrition ◽  
Organ System ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
P Value ◽  
Age Group ◽  
Operative Morbidity ◽  
Medical College ◽  
Protein Energy

Background: Protein energy malnutrition affects every organ system. So correct assessment of nutritional status is important as malnourishment is a risk factor for morbidity and morality in surgical patients. In our study, serum albumin has been taken as parameter for nutritional assessment.Methods: Study is conducted on 50 patients admitted in Department of General Surgery, Dr. Sampurnanand Medical College and associated Hospital, Jodhpur, Rajasthan, India for surgeries during January 2014-December 2015. Data was analyzed using Z-test and Fischer exact t-test and p value was calculated. P value <0.05 is considered statistically significant.Results: Patients with serum albumin <3gm/dl had more complications with maximum number of complications in age group of 41-60 year group. This finding was statistically significant.Conclusions: Low serum albumin patients has more post-operative complication than those with normal level and so is a good indicator of post-operative morbidity and mortality.

scholarly journals Nutritional status changes in children with malignant solid tumor before and after chemotherapy

2016 ◽  
Vol 45 (4) ◽  
pp. 166
Author(s):  
Boris Januar ◽  
Sri S Nasar ◽  
Rulina Suradi ◽  
Maria Abdulsalam
Keyword(s):  
Nutritional Status ◽  
Serum Albumin ◽  
Solid Tumors ◽  
Protein Energy Malnutrition ◽  
Survival Rates ◽  
Albumin Level ◽  
Level Measurement ◽  
Protein Energy ◽  
Before And After ◽  
Malignant Solid Tumor

Background Although aggressive multimodal treatment programsin childhood cancer have significantly increased survival rates, themorbidity caused by protein energy malnutrition related to therapyis still high.Objective To describe nutritional status changes in children withmalignant solid tumors after 21 days of chemotherapy.Methods A descriptive prospective study with pre- and post-testdesign in children with malignant solid tumors was conducted inthe Department of Child Health, Medical School University of In-donesia/Cipto Mangunkusumo Hospital, Jakarta between Janu-ary and July 2004. Anthropometrics (body weight, BW and mid-upper-arm circumference, MUAC) and serum albumin measure-ments were performed before and after 21 days of chemotherapy.Results Twenty-two children were enrolled in this study. After 21days of chemotherapy, 8 children had decreased BW and 6 chil-dren had decreased MUAC, but 3 children gained weight and hadincreased MUAC. Based on MUAC-for-age, 7 children had de-creased nutritional status. Fifteen children had reduced serum al-bumin levels based on a 10% cut-off point. The number of childrenwho had reduced serum albumin was larger than those who hadreduced BW and MUAC. In the evaluation of average oral foodconsumption during 21 days, 7 out of 16 children could acceptmore than 2/3 portion of served food. All of the children who re-ceived enteral feeding could accept more than 2/3 portion of servedfood.Conclusion There was a decrease of nutritional status, BW,MUAC, and serum albumin in most of the subjects after chemo-therapy. Serum albumin level measurement was the more sensi-tive parameter in determining nutritional status changes. Enteralfeeding seems more appropriate to fulfill nutritional needs than oralfeeding

Prognostic implication of KIT mutations in melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9049-9049
Author(s):  
Katherine G. Roth ◽  
Emily C. Zabor ◽  
Marta N. Colgan ◽  
Jedd D. Wolchok ◽  
Paul B. Chapman ◽  
...  
Keyword(s):  
Cox Regression ◽  
Chi Square ◽  
Risk Of Death ◽  
Disease Characteristics ◽  
Kaplan Meier ◽  
Increased Risk ◽  
History Of ◽  
Genetic Subgroup ◽  
Prognostic Implications

9049 Background: The natural history of BRAF and NRAS mutant (mut) melanoma (mel) has been described, but prognostic implications of KIT mut mel have not. Methods: We performed a single-center retrospective review of 180 patients (pts) enriched for mucosal, acral or chronic sun-damaged skin (CSD) mel and screened for KIT, BRAF, and NRAS mut from 4/07 - 4/10 as a part of a phase II imatinib study. Pt/disease characteristics were compared using the Kruskal-Wallis or Chi-square tests. Factors associated with outcomes were assessed by Kaplan-Meier methods and multivariable Cox regression. Results: Median age, 63.7 years; 54.4% male. Primary site: 40% mucosal, 29% acral, 22% CSD, 9% others. Mut rate: 18% KIT, 16% BRAF, 14% NRAS, 52% wild-type (wt). Pathologic subtype differed by genetic subgroup (p<.001) while age, gender, and stage did not (all p>0.05). 18/26 (69%) KIT mut pts received imatinib in the metastatic (met) setting; 6/18 received > 1 other KIT inhibitor. 3/25 (12%) BRAF mut pts received vemurafenib. 8/27 (30%) KIT mut, 4/27 (15%) BRAF mut, 6/20 (30%) NRAS mut, and 6/20 (30%) wt pts received ipilimumab. 149/180 (83%) pts developed mets at a median of 2.15 years (95% CI: 1.72, 2.72). Median follow-up (FU) of pts not developing mets was 3.91 yrs (range: 0.25, 14.34). Older age (HR: 1.02, 95% CI: 1.00, 1.03) and pathologic subtype (mucosal vs CSD HR: 1.70, 95% CI: 1.02, 2.84; non-CSD/unknown vs CSD HR: 2.05, 95% CI: 1.00, 4.21) were associated with increased risk of mets but not with time from mets to death. Of 149 pts who progressed, 123 (83%) died during FU. Median time from met to death was 1.21 years (95% CI: 0.91, 1.67). Median FU from time of mets among those alive at last FU was 2.53 yrs (range: 0.06, 6.85). Mut status including KIT mut was not associated with time to first met or time from met to death. Pts who received ipilimumab from time of first distant met had reduced risk of death (HR: 0.55, 95% CI: 0.36, 0.87) independent of mut status. No impact was observed with KIT inhibition. Conclusions: KIT mut status is not an independent predictor of time to mets or survival in pts with mets. Ipilimumab improved pt outcomes regardless of mut status. The lack of impact of KIT inhibitors is likely due to the heterogeneity of KIT mut in mel but does not preclude efficacy in appropriately selected pts.

Nutritional Status Associated to Skipping Breakfast in Brazilian Health Service Patients

2016 ◽  
Vol 69 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Gislaine Cândida Batista-Jorge ◽  
Antônio Sérgio Barcala-Jorge ◽  
Anderson Frederico Oliveira Dias ◽  
Marise Fagundes Silveira ◽  
Deborah de Farias Lelis ◽  
...  
Keyword(s):  
Health Service ◽  
Nutritional Status ◽  
Overweight And Obesity ◽  
The Body ◽  
Chi Square ◽  
Physically Active ◽  
Dietary Recall ◽  
Increased Risk ◽  
Student’S T ◽  
Skipping Breakfast

Recent studies show that skipping breakfast is associated with an increased risk of obesity, diabetes and cardiovascular diseases. In this context, this study evaluated 400 patients from the Brazilian health service who had their nutritional status defined based on the body mass index and were classified as physically active or insufficient active. The energy intake and macronutrients was also assessed by a 24-hour dietary recall where the association of overweight/obesity with the investigated variables was evaluated using chi-square, Student's t test and multivariate analysis (p < 0.05). The main results showed that more than half of the studied population have the habit of omitting breakfast (55.8%), and among those, 81.2% were overweight/obese (p < 0.0001). Almost three-fourths of these individuals consumed no more than 4 meals a day (73.0%), and regarding this meal frequency/day, 78.8% of the individuals who reported having 4 meals or less a day were overweight/obese compared with 57.8% who reported as having 5-6 meals/day (p < 0.0001). The individuals who reported to omit breakfast had a higher chance of being overweight compared with those who had this habit (OR 2.20; 95% CI 1.40-3.60) and the chance of the physically insufficient active individuals to be overweight/obese was 2.9 times higher when compared to the active individuals (p < 0.0001). Our findings suggest that regular breakfast consumption may decrease overweight and obesity risk.

scholarly journals Y disruption, autosomal hypomethylation and poor male lung cancer survival

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Saffron A. G. Willis-Owen ◽  
Clara Domingo-Sabugo ◽  
Elizabeth Starren ◽  
Liming Liang ◽  
Maxim B. Freidin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Survival ◽  
Prognostic Indicator ◽  
Sexually Dimorphic ◽  
Dna Hypomethylation ◽  
Curative Intent ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage Ia ◽  
Sex Disparity

AbstractLung cancer is the most frequent cause of cancer death worldwide. It affects more men than women, and men generally have worse survival outcomes. We compared gene co-expression networks in affected and unaffected lung tissue from 126 consecutive patients with Stage IA–IV lung cancer undergoing surgery with curative intent. We observed marked degradation of a sex-associated transcription network in tumour tissue. This disturbance, detected in 27.7% of male tumours in the discovery dataset and 27.3% of male tumours in a further 123-sample replication dataset, was coincident with partial losses of the Y chromosome and extensive autosomal DNA hypomethylation. Central to this network was the epigenetic modifier and regulator of sexually dimorphic gene expression, KDM5D. After accounting for prognostic and epidemiological covariates including stage and histology, male patients with tumour KDM5D deficiency showed a significantly increased risk of death (Hazard Ratio [HR] 3.80, 95% CI 1.40–10.3, P = 0.009). KDM5D deficiency was confirmed as a negative prognostic indicator in a further 1100 male lung tumours (HR 1.67, 95% CI 1.4–2.0, P = 1.2 × 10–10). Our findings identify tumour deficiency of KDM5D as a prognostic marker and credible mechanism underlying sex disparity in lung cancer.

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